Leveraging EHR Data to Improve OR Operations: A

University Hospital Case Study

Session 5, February 12, 2019

Dr. Jordan Tannenbaum, MD - Saint Peter’s University Hospital

Mr. Sanjeev Agrawal, President and CMO - LeanTaaS

• Learning Objectives

• About Saint Peter’s University Hospital

• Challenges

• Why We’re Here – Motivation

• What We Did

• Marketplace for Open Time

• Customized OR Management

• Scheduler Effectiveness

• Results

• Comparing Then and Now

• Questions

Agenda

1. Examine how Saint Peter’s increased OR access during

standard business hours for both new and existing surgeons

using data from their EHR

2. Review how Saint Peter’s increased accountability with

actionable, surgeon-centric utilization metrics, resulting in

significant improvement to their OR capacity management

3. Describe why adding visibility helped Saint Peter’s surgeons

better understand the “WHY” behind OR metrics

Learning Objectives

• New Brunswick, NJ

• University teaching hospital

• 10 ORs in 1 location

• 600+ cases a month

• 100+ active surgeons

• AllScripts Paragon

About Saint Peter’s University Hospital

Expensive, “perishable” OR capacity

Poor access to available open time

Significant demand variability among block owners

Proactive scheduling team with manual processes

Minimal insight into data through EHR

Challenges in enforcing accountability for blocks

Challenges

• Each operating room minute

is worth $100 - $300

• A 500-minute day is worth

$50,000 - $150,000

• 1% improvement is worth

$125,000 - $375,000 per

operating room per year

• On average, for a 20

operating room hospital,

improving utilization 3% is

worth $15,000,000 per year

Why We’re Here - Motivation

OR Time Is Precious and

Never Available….

…Yet “Reserved Time” is

Left on the Table Each

Day.

What We Did

Accountability

The current process

for right-sizing blocks

is broken… “Block

utilization” is not

actionable

”Collectable time” is far

more surgeon-centric

and actionable

Visibility

Is reporting “admiring

the problem” or driving

decisions? Are

providers and

administrators

engaged in credible

data?

Becoming more data

and hypothesis-driven

and bring reporting into

the 21

century?

Accessibility

No such thing as a

perfect block allocation

- Block time will never

be used exactly as

planned…

How can we ensure

advance time release,

create visibility into

open time, and making

it simple to request

time – “a liquid

marketplace for open

time”

• Transparency into open time for

surgeon clinics

• Transparency into demand for

OR schedulers

• Ability to release time with

proactive interventions

Marketplace for Open Time

• Flexible, real-time

configuration to set

equipment and staffing

constraints to reflect

real availabilities

• Effective use of robot

Increased Access

• Run fewer rooms than

you have

• Enforce service line

maximum

• Make robot rooms do

robot cases

Customized OR Management

Configurable for How You Run Your ORs

Scheduler Effectiveness

The Right Tools for Your Schedulers

• Centralize transaction

management

• Establish an organized

audit trail

• Enable OR schedulers

to hold time for special

needs (transplant, etc.)

Blocks per Month

Requested

Results

Blocks per Month

Released

70%

Requests From

Surgeons Without

Block Time

15 days

Average Release

Proactivity

Deep Visibility into Metrics

Adopting a Single Source of Truth

• Formalized and

standardized set of KPIs

with goals

• Comprehensive,

accurate, and timely

information

• Deep drill-downs into

the data to granular

level

• Ad-hoc hypothesis

testing with “Explorer”

Open Marketplace as a

Recruitment Tool

Better Capacity

Identification for Tighter

Allocation

Diagnostic Insight into

Current State

Multi-Channel Access

Engage Your Surgeons Anywhere, Anytime

Email Mobile

SMS Chat-bot

Web

Paper

• Access to performance

metrics on both mobile and

web platforms

Delight Providers

Surgeon-Centric Experience

• Weekly text

summary of

personalized KPIs

“pushed” to

surgeons

• Linked to the

mobile web

experience for

deeper

engagement

Collectable Time made it

easier to take blocks away:

• Surgeon-centric, defensible,

and actionable methodology

• Enables conversations with

underperforming block

owners

• High defensibility of data

mitigates back-and-forth for

quick decisions

Identify the right capacity, and

then put it to work.

Data-Driven Block Right-Sizing

Enforcing Accountability

Large Contiguous

Portions of Unused

Time

Abandoned Time Releases Beyond a

Certain Threshold

• OR schedulers and clinic schedulers

dealt with fax, emails, calls, sticky

notes etc.

• Clinic schedulers had no visibility into

true open time inventory

• OR schedulers had no visibility into

true patient flexibility

• No way for OR schedulers to request

or release block ownership in the

EHR

Then…

OR and Clinic Scheduling was a Manual, Cumbersome Process

• No mechanism to

broadcast open time

• No way to release time

in EHR

• No incentive or trigger to

release time

• No way to track releases

• Periop leadership relied

on paper notes to credit

surgeons for releases

Then…

Creating, Accessing, and Crediting Open Time is a Broken

Process

• Clinic schedulers now have full visibility into

open time, and can self-balance based on

patient flexibility

• OR schedulers can now focus on managing

OR constraints and outlier cases

• OR schedulers have visibility into most

demanded times to accommodate as much

volume as possible

• An organized audit trail for scheduling

activities

• Back-and-forth conversations significantly

reduced through digitization

…and Now

OR and Clinic Scheduling is a Highly Streamlined, Centralized,

Digital Process

• Statistics such as “request and release

proactivity” help the OR make data-

driven decisions to set policies

• Transparency into transactional

activities from metrics such as release-

request fill rate helps identify

opportunities

• Ability to easily monitor the

effectiveness of OR initiatives

…and Now

Scheduling statistics provide insights to guide decision-making

• Lack of reliable reporting directly from

EHR

• Spent days each month on creating

metric spreadsheets that were manual

and error-prone

• Definitions and goals were

decentralized

• Data was not surgeon-centric

• Information was disseminated through

email or paper, which was inconvenient

for busy surgeons

Then…

Poor Visibility Into Performance and Lack of Trust in Existing

Data Led to Surgeon Disconnect with Operational Reality

• Primary motivation for initial engagement

• Definitions and goals are clearly

displayed on an interactive dashboard

• Weekly text summary of KPIs – linked to

a mobile web experience for deeper

engagement

• Surgeons often interact, challenge, and

directly engage with the data

• Surgeons are active participants in

having data-driven conversations about

their own performance

…and Now

Surgeons are Actively Engaging with Individual and

Institutional Data

• Challenging to synthesize block

utilization data in a timely manner

• Inconsistent enforcement of block

policy

• Block utilization was frequently

challenged by block owners

• Limited physician involvement in

block management

Then…

Challenges in Repurposing Allocated Block Time

• OR Committee is able to make data-

driven decisions through the Collectable

Time methodology

• Focus on large opportunities and

reusable portions of time

• Repeatable and defensible logic that

accounts for flaws in block utilization

calculation

• Easily generate customizable block

letters for actions taken

…and Now

Decision-Centric Approach to Block Right-Sizing

Please complete the online session evaluation.

Questions

Jordan Tannenbaum, MD

VP/Chief Information

Officer and Chief Medical

Information Officer, Saint

Peter's Healthcare

System

Sanjeev Agrawal

President and CMO,

LeanTaaS

jtannenbaum@saintpetersuh.com sanjeev@leantaas.com